North American Spine Society Public Education Series

Back Pain and
Emotional
Distress
North American Spine Society

Public Education Series
Common Reactions to
Back Pain
Four out of five adults will experience an
episode of significant back pain sometime during
their life. Not surprisingly, back pain is one of
the problems most often seen by health care
providers. Fortunately, the majority of patients
with back pain will successfully recover and
return to normal social and work activities
within 2-4 months, often without treatment.
In 1979, the major professional organization

specializing in pain—the International
Association for the Study of Pain—introduced
the most widely used definition of pain: “an
unpleasant sensory and emotional experience
associated with actual or potential damage, or
described in terms of such damage.” This pain is
a complex experience that includes both physical
and psychological factors.
It is quite normal to have emotional reactions

to acute back pain. These reactions can include
fear, anxiety and worry about what the pain
means, how long it will last and how much it will
interfere with activities of daily living. Though
it’s normal to avoid activity that causes pain,
complete inactivity is ill-advised. Rather, it is
important to take an active role in managing pain
by participating in physician-guided activities.
There are now accepted clinical guidelines for
management of acute back pain (by definition,
within the first 10 weeks of pain) and its
associated stress. These guidelines emphasize:
 Addressing patients’ fears and

misconceptions about back pain
 Providing a reasonable explanation for the

pain as well as an expected outcome
 Empowering the patient to resume/restore

normal activities of daily living through
simple prescribed exercises and graded
activity.
 This should be supplemented, when

necessary, by complementary treatments such
as analgesic medications, manual therapy
and/or physical therapy for symptomatic
relief.
Questions You
Need to Ask
In order to minimize emotional distress, it is

important to ask your health care provider ques-
tions about your back pain so you do not leave
the office uncertain or anxious. Understanding
your pain will help decrease your anxiety. Keep
in mind that, if your pain lasts more than 2-4
months (which is usually considered a normal
healing time for most back problems), your
condition may become chronic. Chronic pain
can be associated with even greater psychological
distress.
During the acute period, feelings of helplessness,

stress and even anger towards your health care
provider (for not relieving your pain) may occur.
In order to help allay this distress, you need to
be sure that your health care provider is attend-
ing to all of your important physical and psycho-
logical needs. You and your health care provider
should do the following:
 You should express your concerns about

your pain symptoms. It is normal for patients
to fear serious disease or disability. Be certain
that your health care provider addresses your
fears through appropriate medical evaluation
and explanation.
 Be certain that your health care provider

fully explains what is being looked for or
ruled out during these evaluations and tests,
and make sure you get the results in terms
you can understand.
 If your health care provider recommends

staying active, be certain that he or she dis-
cusses with you how to stay active safely.
 Inform your health care provider of any
functional difficulties your pain is causing
(eg, problems with bending, lifting, etc.) and
identify with him or her ways to overcome
these difficulties. Also have your health care
provider address any problems you have
performing your normal work activities.
 The information you receive about your di-

agnosis and prognosis should be clear to you.
Make sure you understand the natural pro-
gression of back pain, what “improvement”
can be expected and when it is likely to occur.
 Whenever any recommendations are made,

be sure that you or your health care provider
writes them down so you can review them
after leaving the office.
All of these recommendations are intended to

reduce the emotional concerns and stress most
patients experience with pain. If you are not
satisfied with the treatment and explanations you
receive, consider getting a second opinion from
another health care provider. Anxiety and stress
can actually increase your pain and reduce your
pain coping skills.
Relationship Between
Stress and Pain
It is important to remember that there is a dy-
namic relationship between your state of mind
(eg, stress level) and your physical condition (eg,
pain). Pain can cause stress, which causes more
pain, which causes more stress, and so on. The
more chronic this vicious cycle becomes, the
more likely your emotional distress will increase.
This cycle can be very difficult to break.
Emotional suffering can lead to loss of sleep,

inability to work as well as feeling irritable and
helpless about what can be done. You may feel
desperate and attempt to relieve the pain at any
cost including the use of invasive medical pro-
cedures. Although invasive approaches may be
beneficial for some conditions (such as a herni-
ated disc), often they can be avoided if stress and
pain are managed at an early point in time.
Education and reassurance from your health

care provider goes a long way in preventing or
relieving a great deal of stress and anxiety. You
also need to be proactive about your condition
and treatment. These naturally occurring feelings
of anxiety and stress may cloud your judgment.
Your goal is to avoid getting into a chronic pain
cycle. Reassurance from your health care provid-
er that the pain is only temporary can go a long
way to help you avoid becoming preoccupied
with pain, and prevent unnecessary worry about
the symptoms.
Psychological Interventions
for Back Pain
Fortunately, there are a number of psychological
therapies that have been successfully used in the
management of pain and anxiety. These include
stress management, relaxation training, biofeed-
back, hypnosis and cognitive-behavioral therapy
(a method to reduce feelings of doom and help-
lessness). There are also medications available to
help with sleep problems, anxiety and depres-
sion. Such comprehensive pain management pro-
grams, when integrated with your medical care,
have proven to be quite successful.
Your health care provider can refer you to a psy-

chological management program if it is appro-
priate. Participation in such a program does not
mean the pain is “all in your head” - it is meant
to teach you methods to cope with and control
the pain. Remember, pain is a complex experi-
ence that includes a close interaction of physical
and psychological factors! But together, you and
your health care provider can help you manage
and overcome your pain.
For More Information,
Please Contact:
North American Spine Society

7075 Veterans Boulevard
Burr Ridge, IL 60527
Phone (866) 960-NASS (6277)
Fax (630) 230-3700
Visit Us on the Internet at:

www.KNOWYOURBACK.ORG
DISCLAIMER
The information in this pamphlet is selective and
does not cover all emotional aspects of back pain.
If you have any questions contact your health care
provider for more information.This brochure is for
general information and understanding only and is
not intended to represent official policy of the North
American Spine Society. Please consult your health
care provider for specific information about your
condition.
© 2004-2009 North American Spine Society
Printed on recycled paper.

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Back Pain and

North American Spine Society

In 1979, the major professional organization

It is quite normal to have emotional reactions

 Addressing patients’ fears and

 Providing a reasonable explanation for the

 Empowering the patient to resume/restore

 This should be supplemented, when

In order to minimize emotional distress, it is

During the acute period, feelings of helplessness,

 You should express your concerns about

 Be certain that your health care provider

 If your health care provider recommends

 The information you receive about your di-

 Whenever any recommendations are made,

All of these recommendations are intended to

Emotional suffering can lead to loss of sleep,

Education and reassurance from your health

Your health care provider can refer you to a psy-

North American Spine Society

Visit Us on the Internet at:

© 2004-2009 North American Spine Society

Printed on recycled paper.

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